PMID- 30763752
OWN - NLM
STAT- MEDLINE
DCOM- 20191227
LR  - 20191227
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 125
DP  - 2019 May
TI  - Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome 
      Discharge and the Impact of Disposition on Postdischarge Outcomes.
PG  - e958-e965
LID - S1878-8750(19)30326-2 [pii]
LID - 10.1016/j.wneu.2019.01.214 [doi]
AB  - BACKGROUND: The purpose of this study was to identify predictors for postacute 
      care facility discharge for patients undergoing posterior cervical decompression 
      and fusion (PCDF) and to determine if discharge placement impacts postdischarge 
      outcomes. METHODS: Patients undergoing PCDF from 2012 to 2015 were queried from 
      the NSQIP database (n = 8743) and separated by discharge placement. Outcomes 
      included nonhome discharge, unplanned 30-day readmission, and adverse events 
      (AEs), both before and after discharge. Demographics and comorbidities were 
      analyzed using bivariate analysis. Multivariate logistic regression was used to 
      identify predictors for nonhome discharge, readmission, and severe AE after 
      discharge. RESULTS: Patients with nonhome discharges were significantly older 
      (67.4 vs. 58.6 years; P < 0.001), sicker (82% vs. 54% American Society of 
      Anesthesiologists >2; P < 0.001), and more functionally dependent (16% vs. 3.4%; 
      P < 0.001), with a greater comorbidity burden. Patients with PCDF had an 
      increased likelihood of nonhome discharge if they had a dependent functional 
      status (odds ratio [OR], 2.99; 95% confidence interval [CI], 2.33-3.82; P < 
      0.001), diabetes (OR, 1.32; 95% CI, 1.13-1.55; P = 0.0007), and an American 
      Society of Anesthesiologists >2 (OR, 1.75; 95% CI, 1.5-2.05; P < 0.001), as well 
      as if they were older (OR, 1.06; 95% CI, 1.05-1.06; P < 0.001) and female (OR, 
      1.31; 95% CI, 1.14-1.5; P = 0.0002). Patients with PCDF with nonhome discharges 
      had an increased likelihood of having a severe postdischarge AE (OR, 1.71; 95% 
      CI, 1.26-2.33; P = 0.0006) and an unplanned readmission (OR, 1.45; 95% CI, 
      1.15-1.82; P = 0.002). CONCLUSIONS: Results of this cross-sectional study suggest 
      that patients with PCDF discharged to a postacute care facility have a higher 
      likelihood of having a severe AE after discharge as well as a higher likelihood 
      of being readmitted.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Snyder, Daniel J
AU  - Snyder DJ
AD  - Department of Medical Education, Icahn School of Medicine at Mount Sinai, New 
      York, New York, USA. Electronic address: Daniel.Snyder@Icahn.Mssm.Edu.
FAU - Neifert, Sean N
AU  - Neifert SN
AD  - Department of Medical Education, Icahn School of Medicine at Mount Sinai, New 
      York, New York, USA.
FAU - Gal, Jonathan S
AU  - Gal JS
AD  - Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai 
      Hospital, New York, New York, USA.
FAU - Deutsch, Brian C
AU  - Deutsch BC
AD  - Department of Medical Education, Icahn School of Medicine at Mount Sinai, New 
      York, New York, USA.
FAU - Caridi, John M
AU  - Caridi JM
AD  - Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA; 
      Department of Orthopedics, Mount Sinai Hospital, New York, New York, USA.
LA  - eng
PT  - Journal Article
DEP - 20190211
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
SB  - IM
MH  - Aged
MH  - Cross-Sectional Studies
MH  - Decompression, Surgical/adverse effects
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Discharge/statistics & numerical data
MH  - Patient Readmission/statistics & numerical data
MH  - Postoperative Complications/*epidemiology
MH  - Rehabilitation Centers/statistics & numerical data
MH  - Risk Factors
MH  - Skilled Nursing Facilities/statistics & numerical data
MH  - Spinal Fusion/*adverse effects/methods
OTO - NOTNLM
OT  - Bundled payments
OT  - Episode-based outcomes
OT  - Nonhome discharge
OT  - Outcomes
OT  - SNF
OT  - Unplanned readmission
EDAT- 2019/02/15 06:00
MHDA- 2019/12/28 06:00
CRDT- 2019/02/15 06:00
PHST- 2018/10/13 00:00 [received]
PHST- 2019/01/21 00:00 [revised]
PHST- 2019/01/22 00:00 [accepted]
PHST- 2019/02/15 06:00 [pubmed]
PHST- 2019/12/28 06:00 [medline]
PHST- 2019/02/15 06:00 [entrez]
AID - S1878-8750(19)30326-2 [pii]
AID - 10.1016/j.wneu.2019.01.214 [doi]
PST - ppublish
SO  - World Neurosurg. 2019 May;125:e958-e965. doi: 10.1016/j.wneu.2019.01.214. Epub 
      2019 Feb 11.